This collection of 150 sonnets takes us through the journey
from the writer’s wife’s diagnosis with Parkinson’s, eventually complicated by
dementia and overmedication, to her death and his early days of grieving. Married for over 40 years and close
companions, their successive separations deal new blows as they happen: She
goes into skilled nursing care, gets lost in delusions, and becomes more frail
and erratic, finally succumbs after a fall and a short period in a coma. The writer draws on biblical metaphors and
threads memories of their earlier life together in fleeting images so that the
reader is left to infer from glimpses a rich and happy marriage that, he
reflects, prepared them—but not enough—for this going.

Haunted by grief over the loss of his young daughter, Felix is a gifted director at a theatre festival. He plans an inspired interpretation of The Tempest,
but is unfairly ousted from his beloved position by a jealous and inadequate
rival.As his fortunes dwindle, he accepts a position to promote literacy in a local prison—and
hits upon the idea of using his newfound but incarcerated protégés to mount his
long-planned Tempest. The project
encounters financial difficulties that begin to seem insurmountable as his hostile
rival assumes an influential government position.The result exceeds all expectations, helps to heal his grief,
and with its unorthodox staging, provides a delicious revenge.

The book opens with Shep
Knacker packing his bags for his long-dreamed of “Afterlife”—his word for
retirement—in Pemba, an island off the coast of Tanzania. He plans to take his
wife, Glynis, and his high school aged son, Zach. This plan is not unexpected
because Shep and Glynis have made many “research” trips during their 26-year
marriage to find the right place (though never to Pemba). But, there were
always reasons not to act on their research. An intervention was needed. Glynis
is not home while he is packing because she is at some “appointment.” When she
gets home, Shep informs her of his plans for the three of them to leave for
Pemba, and he further informs Glynis that he’s going whether she comes or not.
In response, she informs him that she has cancer—a bad one (mesothelioma); he
unpacks, so much for that.

What unfurls from there is
more complicated than just the challenges Glynis’s disease produces, though
these are monumental challenges. Other people, too, are in need of Shep’s
attention. His father’s decrepitude is advancing, his sister is on the brink of
homelessness, and his teenage son is detaching from him and life in general.
Shep eventually loses his job as an employee at the handyman company he once
owned (“Knack of All Trades”) then sold to fund his Afterlife. There’s more.

Shep's best friend,
Jackson, who also worked with him at Knack of All Trades has two girls, and one
of them has familial dysautonomia. This progressive genetic disease of the
nervous system produces a constellation of medical problems that are bizarre,
intense, and serious, before it ultimately produces a tragic end. The trauma
and tragedy this disease inflicts in this story (and in life) encompass the
entire family, in spite of the heroic efforts of Jackson’s wife, Carol.

The many plot lines in this
novel at times proceed independently of one another, and at other times
intersect. They concern serious illness experiences and the effects they have
on families and also how the American health care system can place burdens on those who need it. Nevertheless, the two families,
beaten down by illness, fatigued from encounters with doctors and hospitals,
and exasperated from fights with insurance companies, rally enough to make it
to Pemba. The trip becomes financially affordable as the result of some
narrative gimmickry involving a financial settlement of $800,000 from the company
that put asbestos in equipment Glynis had used years before. They would spend
the rest of their lives there, longer for some than for others.

The play has two characters: Ruth and Friend (who is a male doctor).Ruth is an engaging, straight-talking quadriplegic who can zip and dance with her chin-operated wheelchair and takes delight in terrorizing medical staff both physically and verbally. She wants to write poetry and is waiting for a device to make it possible for her to use a computer. She keeps developing bedsores that threaten her life and require long admissions to the hospital before they will heal. She desperately wants to live no matter what happens, as she feels that having no mind would be worse than having no body.Friend is a male doctor with children who is ashamed of having examined her while she was unaware. Burdened with his guilt, he asks to be her “friend.” Ruth is skeptical and runs circles around him, but eventually comes to trust him and believe in his sincerity.She makes him a witness to her advance directive to instigate all heroic measures, as she is afraid of the kindly "ethical" and cost-effective arguments not to treat the disabled. But Ruth dies horribly from sepsis, and Friend is helpless to prevent it. She never obtains the device that would have allowed her to put her poems into printed words.

An artist, Ruth, lives with quadriplegia and manages to drive
(and dance) with a special wheelchair that she controls with her chin. She also
enjoys terrorizing doctors in the hospital corridors, where she is seen on a
regular basis because of frequent bouts of infected bedsores. She has a new
computer and is “patiently waiting for” a biomedical engineer to set it up to manage, like her chair, with her chin. She wants to write, to draw, to
create. But the wait list is long, technicians scarce, and every candidate
deserving.

On one of her admissions, Ruth meets the physician-narrator who is appalled by a medical resident’s lack of
empathy in relating her case as if she were not present. Distressed by the
encounter, the doctor is all the more disturbed when he notices that Ruth’s
birth date is the same as his own.

He tries to make it up to her by
withdrawing from her care in order to be her “friend,” one who tries to
understand and will defend her strong desire to live despite her disability. Driven
by curiosity about her past, her sharp wit, and how she faces each day, the
doctor never quite achieves his goal and constantly feels guilty for letting
her down as an advocate and a friend, and possibly also for being able-bodied
himself. He never visited her in her
group home, and when she comes to hospital in florid sepsis, he is unable to prevent
his colleagues from letting nature take its course. His own bout with severe
illness, possibly MS—more likely a stroke--resonates with Ruth’s plight. Long
after her death, he can imagine the acid remarks that she would make about his foibles.

A civil war rages inexorably in J. M. Coetzee’s
novel, Life & Times of Michael K.
Details of the war are vague, but the fighting will determine whether “minorities
will have a say in their destinies” (Coetzee 157). Riots splinter communities,
peoples are displaced, the military patrols and slaughters, and prison camps
are erected. The novel’s first half introduces an unlikely protagonist at the
center of the bloody tumult: Michael K, a municipal gardener—a gentle “simpleton”
with a harelip “curled like a snail’s foot”—who cares for his ailing mother in
Cape Town (3). Sick and unable to work, K’s mother resolves to return to her
birthplace and girlhood home, Prince Albert, a far-flung cluster of homesteads
in the Karoo, where she hopes to convalesce peacefully. Their migration
permits, however, never arrive, likely lost in the abyss of State bureaucracy.
Gathering his mother and their few possessions in a makeshift wheelbarrow, K
attempts the arduous journey anyway but the passage is thwarted by a government
checkpoint. As his mother’s condition deteriorates, she is hospitalized and
dies, her body cremated before K gives hospital officials consent.

The novel’s lulling elliptical cycle pushes K
along the currents of departure and circumvention, to capture and escape.
Pressing on to Prince Albert where he will deliver his mother’s remains, K is
arrested and incarcerated in a railcar where he and other prisoners remove
landslide rubble from a remote part of the rail line. Released after finishing
the labor, K arrives to Prince Albert where he settles on the property of the
ramshackle homestead and begins contentedly scavenging. Far from the tremors of
war, he hunts birds, nibbles roots and bulbs, turns over rocks for grubs, drinks
from streams, and, in a fit of wild hunger, drowns and slaughters a wild goat. All
the while he finds a package of pumpkin and melon seeds that for the rest of
his time on the property he will sedulously plant and water— “[t]his was the
beginning of his life as a cultivator” (59). Immersed in this blanched world,
at the center of its arid winds and mineral expanses, K devotedly coaxes his
mean crop to life. But the war encroaches on K’s hiding place and he absconds
to a mountain cave where he hides, and nearly starves.

The stillness, silence, and sunlight of the
Karoo seep into K’s bones: “If I were cut, he thought, holding his wrists out,
looking at his wrists, the blood would no longer gush from me but seep, and
after a little seeping dry and heal. I am becoming smaller and harder and drier
every day” (67). Imperceptibly, K becomes the ephemeral ‘stuff’ of this harsh
land: “He thought of himself not as something heavy that left tracks behind it,
but if anything as a speck upon the surface on an earth too deeply asleep to
notice the scratch of ant-feet, the rasp of butterfly teeth, the tumbling of
dust” (97). K is shortly captured by the military and forced into a
resettlement camp. Through the elliptical current of the novel, he escapes and returns
to the Prince Albert homestead, where he finds his crop trampled. He nourishes
the vines back to life and, in a moment of lonely exaltation, grills pumpkin
flesh: “All that remains is to be a tender of the soil. […] He chewed with
tears of joy in his eyes” (113). What K seeks, or what is seeking him, is a life
of solitude, remote from peril and unrest, living in quiet reciprocity with the
earth, exercising simple cultivation—a skill conspicuously anachronistic (but
universally essential) in an age marked by the depravities of war.
Wringing nourishment from veld-grown pumpkins,
however, leaves K famished, and winds and squalls gut his makeshift shanty. Soon
K is picked up, again, by a military patrol (he is suspected of abetting rebels
camping in the mountains) that consigns him to a government hospital. The
novel’s latter half is narrated by the hospital’s medical officer, a caring man
who, doubtful of the war’s objectives, takes special interest in K’s recovery.
By now, severely malnourished, K resembles “someone out of Dachau” (146). The
medical officer is baffled by K, not for his uncooperative responses nor
refusal to eat hospital food, but because of his status as a kind of ahistorical
oddity in a time of modern warfare: “a human soul above and beneath
classification, a soul blessedly untouched by doctrine, untouched by history, a
soul stirring its wings within that stiff sarcophagus […] a creature left over
from an earlier age, like a coelacanth or the last man to speak Yaqui” (151).
The medical officer realizes K’s condition lies beyond simple diagnosis; rather,
K’s body craves “a different kind of food, food that no camp could supply”
(163). Sometime in the night, K vanishes from the hospital with his packet of
pumpkin seeds, moving toward another remote patch of earth to cultivate.

Intern, Maggie Altman, begins her postgraduate training in a large Texas hospital where a new computerized system has been implemented to improve service. She pours heart and soul into her work, but her admissions always seem to be the sickest patients who keep dying, sometimes inexplicably. Maggie becomes suspicious of her colleagues and of Dr. Milton Silber, an irrascible, retired clinician with no fondness for the new technology. Silber also happens to be a financial genius. Overhearing conversations and finding puzzling papers, Maggie imagines a scam, in which her supervisors may be eliminating dying patients to reduce costs, improve statistics, and siphon funds to their own pockets.

The bad outcomes for Maggie's patients are noticed and criticized, and she is pressured to drop out, switch hospitals, or go back into research. She senses that the perpetrators are aware of her suspicions and send her the worst patients in an effort to eliminate her. She trusts no one. These worries are compounded by her own illness and her accidental discovery in the morgue of a traffic in unclaimed bodies. With the help of excellent clinical skills, true friends, Dr. Silber, and a new love interest who is a budding financial genius, she survives physical and emotional violence and solves the mystery of patient homicides, poisonings, and fraud.

Approaching age 60 and childless, Fiona Maye is
a family court judge who must decide if 17 year-old Adam has the right to
refuse blood transfusions for his leukemia. He and his parents are Jehovah’s
Witnesses. The Children Act does not
allow a child to make this decision until age 18. Fiona is an atheist and her
35-year marriage to an academic is falling apart. She takes the extraordinary step of visiting
Adam to know him and understand his conviction. He is beautiful and gifted, he
writes poetry and plays violin. Why would he not want to try to live? She makes
her decision having no idea if it will be morally, legally or medically right. To say more would spoil it.

Dr. Monika Renz’s work with dying patients is unusual if not
unique in the way she appropriates and applies insights from Jungian depth
psychology, practices available in patients’ faith traditions, and musically
guided meditation to invite and support the spiritual experiences that so often
come, bidden or unbidden, near the end of life.
An experienced oncologist, Dr. Renz offers carefully amassed data to support
her advocacy of focused practices of spiritual care as a dimension of
palliative care, but is also quite comfortable with the fact that “neither the
frequency nor the visible effects of experiences of the transcendent prove that
such experience is an expression of grace” because “unverifiability is
intrinsic to grace.” Still, her long
experience leads her to assert not only that “grace” can be a useful,
practical, operative word for what professional caregivers may witness and
mediate but also that affirmation and support of patients’ spiritual,
religious, or transcendent experiences in the course of dying can amplify and
multiply moments of grace, which manifest as sudden, deep peace in the very
midst of pain, profound acceptance, openness to reconciliations, or significant
awakenings from torpor that allow needed moments of closure with loved ones. Describing herself as “an open-minded
religious person and a practicing Christian,” she reminds readers that God is a loanword, whose basic form in
Germanic was gaudam, a neutral
participle. Depending on the
Indo-Germanic root, the word means “the called upon” or “the one sacrificed to
. . . .” Openness to the divine in both
patients and caregivers, Dr. Renz argues, can and does make end-of-life care a
shared journey of discovery and offer everyone involved a valuable reminder that
medicine is practiced, always, at the threshold of mystery.

Victoria Sweet describes her training in medical school,
residency, and work in various clinics and hospitals. From all of these she
forms her own sense of what medical care should include: “Slow Medicine” that
uses, ironically, the best aspects of today’s “Fast” medicine.

Her dramatic “Introduction: Medicine Without a Soul” describes poor—even
dangerous—care given to her elderly father at a hospital. An experienced
physician, she calls Hospice and saves him from a “Death
Express” the hospital has “quality-assured” (pp. 6, 8).

The book continues with 16 chapters in chronological order. The first ten
describe Sweet from a late ‘60s Stanford undergrad and “a sort of hippie”
(p.14), next a learner of “facts” in preclinical studies at Harvard, plus the
clinical rotations (including Psychiatry, Internal Medicine, Pediatrics, and
electives), then an internship as a doctor and her work in various clinics and
hospitals. Throughout she’s collecting skills, concepts, even philosophies
(Jung, feminism, Chinese chi, value of stories). She also describes
particular patients important to her learning. She dislikes “just good enough”
medicine at the VA (p. 95), “unapologetic budgetarianism” (p 141), medicine
that is reductive and uncaring, and futile care for dying patients.
Halfway through, we find an “Intermission: In which Fast Medicine and Slow
Medicine Come Together.” With a year off, Sweet signs on as physician for a
trekking group headed for Nepal. Unexpectedly, she treats an Englishman in the
Himalayas. Returning home, she treats a man whose pulse is declining and rides
a helicopter with him to a hospital. She realizes that she can take on the full
responsibility of being a doctor, including when to use Fast medicine
and when to use Slow.

The following chapters deal with the 1980s emergence of AIDS, a hand injury to
Sweet (she sees herself as “a wounded healer,” p. 182), her new understanding
of medicine as “A Craft, A Science, and an Art” (Chapter 12) and conflicts between
medical care and economics-driven medicine (“checked boxes,” administrators,
quality assurance, even outright corruption). She scorns use of the
labels “health-care providers” and “health-care consumers” (p. 211) and
discovers Hildegard of Bingen’s medieval vision of medicine. She works for 20
years at Laguna Honda, the topic of her earlier book God’s Hotel(2012). Chapter 16 closes the book with “A Slow Medicine Manifesto.”

Sweet pays tribute to her teachers, both in a dedication to the book, and
throughout the pages: professors, preceptors, nurses—especially a series of
Irish Kathleens—and patients. There are some 20 case studies of patients
throughout the book, their medical dilemmas, their personalities, and Sweet’s Slow
Medicine that involves creating a healing relationship with them, finding the
right path for treatment, even watching and waiting.